Introduction
Background
Integration and collaboration
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Active collaboration - the highest level - partnerships have been developed and are sustainable despite changes within healthcare systems. Goals have been developed and supported by policies. Trust is evident as all parties understand their own and each other’s roles and responsibilities. A strong working relationship can often lead to inter-professional and inter-organisational innovation.
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Developing collaboration - collaborative practices have commenced but remain unstable especially when faced with change. Goals, leadership and policies are still being negotiated which may result in some conflict. Roles and responsibilities are still divided. Services are less efficient but change is occurring.
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Potential collaboration - collaboration does not exist and is blocked by ongoing conflict. Negotiations breakdown with resultant loss of accessibility and continuity. Conflict needs to be overcome before collaboration can occur [20].
Study aim
Methods
Setting
Participants and data collection
Professionals
Women service-users
Medical record review
Data analyses
Results
Profile of the professionals
Profile of the women
The role of the PIMH service
My role is to help support [women] in such a way that their mental health can be … in such a place … that they have the best relationship that they can possibly have with their infant. (P5)
Themes
Type of contact
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PIMH clinician to other service provider - verbal
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Other service provider to PIMH - verbal
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PIMH clinician to other service provider –written
f
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Other service provider to PIMH - written
f
|
Face to face meeting
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---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Ce | n | % | Ce | n | % | Ce | n | % | Ce | n | % | Ce | n | % | |
Maternity services
a
| 0 | 150 | 61.5 | 0 | 187 | 76.6 | 0 | 115 | 47.1 | 0 | 236 | 96.7 | 0 | 239 | 98.0 |
1−2 | 79 | 32.4 | 1−2 | 52 | 21.3 | 1−2 | 115 | 47.1 | 1−2 | 8 | 3.3 | 1−2 | 5 | 2.0 | |
N = 244
| 3−5 | 13 | 5.3 | 3−5 | 4 | 1.6 | 3−4 | 13 | 5.3 | ||||||
7 | 1 | 0.4 | 6 | 1 | 0.4 | 6 | 1 | 0.4 | |||||||
13 | 1 | 0.4 | |||||||||||||
Child & family health nursing services
a
| 0 | 201 | 82.4 | 0 | 210 | 86.1 | 0 | 197 | 80.7 | 0 | 240 | 98.4 | 0 | 238 | 97.5 |
1−2 | 34 | 13.9 | 1−2 | 29 | 11.9 | 1−2 | 44 | 18.0 | 1−2 | 3 | 1.2 | 1−2 | 6 | 2.5 | |
N = 244
| 3−4 | 8 | 3.3 | 3−5 | 4 | 1.6 | 3 | 3 | 1.2 | 3 | 1 | 0.4 | |||
6 | 1 | 0.4 | |||||||||||||
General practitioner
a
| 0 | 226 | 92.6 | 0 | 238 | 97.5 | 0 | 195 | 79.9 | 0 | 242 | 99.2 | 0 | 244 | 100 |
1−2 | 17 | 7.0 | 1 | 6 | 2.5 | 1−2 | 47 | 19.3 | 1 | 2 | 0.8 | ||||
N = 244
| 3 | 1 | 0.4 | 3 | 2 | 0.8 | |||||||||
Maternity social worker
b
| 0 | 210 | 86.1 | 0 | 226 | 92.6 | 0 | 235 | 96.3 | 0 | 235 | 96.3 | 0 | 236 | 96.7 |
1−2 | 26 | 10.6 | 1−2 | 17 | 7.0 | 1−2 | 7 | 2.9 | 1−2 | 8 | 3.3 | 1−2 | 7 | 2.9 | |
3−5 | 7 | 2.9 | 3−5 | 1 | 0.4 | 3−5 | 2 | 0.8 | 3−5 | 1 | 0.4 | 3−5 | 1 | 0.4 | |
N = 244
| |||||||||||||||
7 | 1 | 0.4 | |||||||||||||
Adult mental health (Community)
b
| 0 | 226 | 92.6 | 0 | 230 | 94.3 | 0 | 240 | 98.4 | 0 | 239 | 98.0 | 0 | 243 | 99.6 |
1−2 | 11 | 4.5 | 1−2 | 10 | 4.1 | 1 | 2 | 0.8 | 1 | 4 | 1.6 | 1 | 1 | 0.4 | |
3−5 | 5 | 2.0 | 3−5 | 4 | 1.6 | 3−4 | 2 | 0.8 | 4 | 1 | 0.4 | ||||
N = 244
| 9 | 2 | 0.8 | ||||||||||||
Child protection services
c
| 0 | 223 | 91.4 | 0 | 230 | 94.3 | 0 | 237 | 97.1 | 0 | 240 | 98.4 | 0 | 241 | 98.8 |
1−2 | 13 | 5.3 | 1−2 | 11 | 4.5 | 1−2 | 6 | 2.5 | 1 | 3 | 1.2 | 1 | 2 | 0.8 | |
3−5 | 5 | 2.0 | 3 | 2 | 0.8 | 4 | 1 | 0.4 | 3 | 1 | 0.4 | 3 | 1 | 0.4 | |
N = 244
| 7 | 2 | 0.8 | 8 | 1 | 0.4 | |||||||||
10 | 1 | 0.4 | |||||||||||||
Non-government organisations
d
| 0 | 206 | 84.5 | 0 | 218 | 89.4 | 0 | 233 | 95.5 | 0 | 233 | 95.5 | 0 | 233 | 95.5 |
1−2 | 21 | 8.6 | 1−2 | 16 | 6.6 | 1−2 | 9 | 3.7 | 1−2 | 10 | 4.1 | 1−2 | 12 | 4.9 | |
3−5 | 7 | 2.9 | 3−5 | 4 | 1.6 | 3−5 | 2 | 0.8 | 3−5 | 1 | 0.4 | 11 | 1 | 0.4 | |
6−8 | 5 | 2.0 | 6−8 | 5 | 2.0 | ||||||||||
N = 244
| |||||||||||||||
9−11 | 4 | 1.6 | 10 | 1 | 0.4 | ||||||||||
19 | 1 | 0.4 |
[Phone call] to Child & Family nurse … She looked at file & noted that baby has not been seen by them. They were not aware of antenatal risk factors or PIMHS involvement. Told that [mother] was seen regularly by PIMHS in pregnancy – postnatally only seen once … then have not been able to contact. Nurse will document in the file. Plan: File to be closed. File closed. (MR109)
Those interagency meetings … make a difference … [they] build our relationships with each other … [and] it’s helped [to] have a more integrated model. (P1)
Attended case conference [with Child Protection Services] … PIMHS to assess mum’s [mental health] status … Outcome of this will determine plan. (MR003)
It’s primarily for the maternity … and child and family health [services], … it needs to be a fairly, … comprehensive management plan, so that … [other services] know what we’re going to be doing and who’s going to be doing it, … who’s involved with the woman’s care … [It also provides information about] the vulnerabilities … [for example] depression, anxiety, … dissociative episodes, … identification of what her triggers are, what it would look like if she’s being triggered, and then … how the staff can help her manage that. (P5)
I think moving to where the other services are or being in close proximity to the other services, … provides … a much smoother type [of] service for communication (P4) [and has] helped PIMHS to be more integrated across mental health. (P3)
They [adult mental health] don’t fully understand what it is we do … And that’s not through lack of trying (laugh). I’ve been out there doing lots of in-service and lots of education and … it’s going to continue, we’ll just continue to roll out education, education, education … [to help them understand that] we’re not just babysitters, we’re not someone just holding these women’s hand through the pregnancy period and … going for cups of tea … so … it’s getting [them] to see … the integrity of the service that we actually offer. [Otherwise they keep] trying to refer clients to other services … during the perinatal period.” (P5)
A lot of [the women’s] issues may well be around the birth, and the perinatal and infant mental health worker doesn’t even know for six days if the woman’s had a baby … I think “how is this possible? How do the midwives not know this woman’s with that worker, or the worker’s not there?” … and then the woman is coming to that most anxious time, and the support structures, it’s then like, “I didn’t know she’d had a baby” … If you don’t understand the volume and … activity in that maternity ward, you’ll never understand why a beautifully-written perinatal care plan doesn’t even get sighted, unless a social worker somewhere gets involved. (S4)
I don’t do … [case management] with everybody … I would prefer not to because I don’t really see that as much as our role … we’re kind of specialised to mental health service. There’s a lot of people who probably do it better than I do. (P2)
We’ve had situations where some PIMHS clinicians will go to the ward’s social worker and ask for assistance around … housing or transport, and we don’t particularly like that because, if you’ve worked with a client antenatally and you’re going to keep seeing them postnatally … we think it’s appropriate that they would … follow that up themselves, they’re the primary clinician, … we support the worker in saying “why don’t you try this?” We don’t just say “go away” (laughs) … but we won’t do it. (S2)
[PIMH clinician] referred us to [name of service] … to have something but I guess I don’t really understand … I wasn’t really sure what the [service] person was supposed to be doing so it was a bit confusing (laughs). (Tanya)
[PIMH] send people who aren’t able to make the decisions … So we meet, make … a decision and then it’s not until the next meeting three months later that they say, “oh no we didn’t actually … like that”. (S4)
We’ve been trying to encourage them [the postnatal ward and birthing unit managers] to come [to the case review meetings] but they don’t think it’s necessary … [but] we’d like them to come because we think it is important that they know [the women] and so the care plans don’t get missed. (S1)
It’s the midwife who’s left to support that woman through the pregnancy, either because they’ve not [stress on tape] consented to service, or they’ve disengaged from service, they’ve changed their mind, or there is no service … So how do we get all of that knowledge to midwives? (S3)
Social work is the lead clinician involved in child protection when there’s assumptions of care on the ward … this happened quite recently, where a woman … was being case managed by PIMHS, and then suddenly Community Services turned up and … no one was available from PIMHS, so social work just had to jump in … It didn’t actually end up being an assumption [of care], but we had to do this assessment, be there for a woman who we’d never met … So I guess that there’s those issues around … trying to work well together and identifying mental health, troubleshoot, you know … where do the links happen? (S2)
You’re only disclosing what the clients are comfortable for you to disclose as well … and some people expect more than what the client’s comfortable [with] … that’s not okay. (P7)
They’ll come for maybe one or two sessions and then they don’t come anymore. This is with the postnatal stuff. This is where the gap is. So we don’t see them. Unless we’re vigilant, unless we’re looking every day to see if this lady’s delivered, we don’t get notified that they’ve delivered. So that’s often the reason why there’s been a big gap in between … They go home and they disappear”. (P4)
They tried to transition [me] into another service, and that has not been successful … not because of me, but because the other service just … keeps forgetting (chuckles) … It’s very disappointing to me … I know I could ring the social worker, but …, you … get to a point now when they haven’t called you … three times when they said they would, … I don’t want to put myself out and call. I’m not comfortable with that now. (Patricia)